In May 2022, members voted to liquidate a 136-year-old institution. And so the New Zealand Medical Association (NZMA) ceased to be.

Yes, you heard me correctly. The NZMA no longer exists.

At the time when this took place in 2022, New Zealand had about 17000 doctors, of which only about 1200 were full subscription-paying NZMA members.

The last Chairman of the Board of the NZMA, Dr Alistair Humphrey, said  “The financial position of the association is unsustainable”. He also said, “Two decades of stagnant membership and the accumulation of deficits has reached the point where we must dissolve, or we will soon become insolvent and unable to meet our obligations to staff and creditors”.¹

This did not happen in a faraway country that is unfamiliar to Singapore doctors. This happened very recently in a Commonwealth, Anglophone country with a medical profession that is comparable with Singapore in terms of numbers and quality. (Singapore has about 16000 doctors now).

This sad episode serves as a warning to all of us involved in the leading or running of non-government medical professional bodies in Singapore. As with running any organisation based on voluntary membership, financial viability is a pre-requisite for continued existence. Financial viability in turn depends to a large extent of having good income streams from members’ subscriptions and fees charged for activities.

Having a large membership base and charging fees for running well-attended activities therefore are the key elements for ensuring financial viability. These are the brass tacks of running a professional body such as AMS and they point to the issue of relevance.

Are we relevant to the people we claim to represent, the specialist doctors?

This is a question that I have heard often in my 13 years of being an elected Council member of AMS. How we can be relevant, or rather be more relevant? Truth is, there are many naysayers and detractors who claim AMS is not relevant to them. Hence they either do not join or quit after having joined. And I must say, we should not be dismissive of such remarks too. No smoke without fire and we must always ask ourselves where have we fallen short and where we can do better. And there is always much room for improvement.

When a person says we are irrelevant, what he or she really means is that what we are doing has little alignment with the interests of that person. Having said that, AMS does not claim to represent personal interests but group interests. For example, AMS claims to represents the interests of specialists, and the College of Physicians Singapore claim to represent the interests of physicians in Singapore.

In terms of person and group dynamics, there are at least three reasons to explain this non-alignment which amounts to irrelevance:

• We fail to understand what are the interests of this person or the interests of the larger group that this person belongs to
• We understand the interests of this person, but we fail to align our actions and activities with his or his group’s interests and the advancement of these interests
• We claim to represent a group of people (not a person) and sometimes the interests of the group and this person may differ. This is a difficult issue which we shall address another day.

Further complicating the situation is that we represent a group of people that subscribes to a higher calling that transcends and rises above self-interests. Medicine is fundamentally a force for good and the medical profession is often asked to sacrifice self-interests so that our patients can have greater benefit. This is the essence of the fiduciary duty that we owe our patients. It is the same duty that underscores the patient-doctor relationship, the elements of which is encapsulated in the SMC Physicians Pledge that was first introduced 30 years ago.

If it were not so, there would not be so many obituaries in the newspapers with the families of the deceased thanking healthcare workers, in particular doctors. This example may seem trite, but it is not. It points to the high regard society has for us and reminds us to always remain true to the cause and calling of being a doctor.

And so AMS has a rather difficult balance to strike. It is like walking a tightrope high up in the air.

On one hand, we have to always nudge our fellows in the direction of more professionalism, excellent technical standards and even selflessness, so that the interests of our patients are best served. This is one half of the advocacy work of the AMS: AMS exists to make us better doctors, better specialists, and dare I say it – better human beings.

On the other hand, we have to stay sensitive and relevant to the real-life difficulties of being a specialist in today’s world: the competition that exists within and between specialties, the challenges of developing a career while maintaining work-life balance, ever-rising patient expectations, and in the private sector, the adverse and worsening health insurance climate and rising business costs etc. This is the other half of the advocacy role AMS has, so that we can defend our fellows’ right to practice medicine and make a living in a reasonably congenial climate.

AMS has to be the voice of the specialists in both these areas.

Advocacy consumes resources, both in terms of time, effort and money. But even more fundamental than time, effort and money is the priceless currency of credibility. We can only advocate effectively if we are perceived to be credible by others: the public, the government, the media etc. If our behaviour and actions are seen to be self-servicing, myopic or lacking in substance, then no amount of time, money and effort can salvage our advocacy agenda.

So while the continued existence of AMS depends on financial viability, the paradox here is that the elemental forces that determine its existence, such as credibility and relevance, cannot be measured in dollars and cents.

Let us not euphemise this. This is a tightrope that AMS is destined to walk. But walking a tightrope has it’s pluses too. It makes us develop a heightened sense of danger and stay singularly focused on the purpose before us. All this helps AMS stay relevant and not end up like the dodo bird.

In 2023, when I received your strong mandate to lead the AMS in the Master-elect elections, I was again reminded of how I felt in 2006 when I was elected as the President of the Singapore Medical Association (SMA) – I was deeply conscious of the magnitude of the task and the weight of the office. 18 years later, I am older and hopefully wiser but no less grateful and overwhelmed by this singular honour you have bestowed on me. 

I know that with your continued support, my fellow council members and I will guide AMS to walk this tightrope with a good measure of optimism, calm and confidence.